Healthcare Provider Details

I. General information

NPI: 1598909103
Provider Name (Legal Business Name): ANA JIMENEZ PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/27/2009
Last Update Date: 12/16/2019
Certification Date: 12/16/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

520 SUPERIOR AVE STE 225
NEWPORT BEACH CA
92663-3667
US

IV. Provider business mailing address

441 ENCLAVE CIR APT 304
COSTA MESA CA
92626-8264
US

V. Phone/Fax

Practice location:
  • Phone: 949-360-0300
  • Fax: 949-360-6932
Mailing address:
  • Phone: 260-446-2724
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number10000833A
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number23197
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: